ASHP therapeutic position statement on the preferential use of metronidazole for the treatment of Clostridium difficile-associated disease.

ASHP supports preferential use of oral metronidazole for treating CDAD when antimicrobial therapy is indicated. Oral vancomycin should be reserved for severe, potentially life-threatening cases or when oral metronidazole cannot be used. Oral metronidazole is as safe and effective as oral vancomycin and is considerably less costly. In addition, preliminary data suggest that routine use of oral vancomycin for CDAD may contribute to the spread of VRE--emerging nosocomial pathogens that can be extraordinarily difficult to treat. Pharmacists should work to foster preferential prescribing of oral metronidazole for the treatment of CDAD. Pharmacists should also actively seek opportunities to educate health care providers and counsel patients about the risks associated with the indiscriminate use of vancomycin and other antimicrobial agents.